Another case series of 3 resuscitative hysterotomies, all performed by obstetricians, reported 33% maternal and 67% neonate survival.(1).
The mechanics of the procedure are:
“Duration should not exceed 5 minutes!
Incise from pubic symphysis to at least umbilicus with a large scalpel along linea nigra into peritoneal cavity. Layers: skin, subcutaneous tissue, fascia between the rectus muscles, peritoneum.
Retract abdominal wall laterally
Reflect bladder inferiorly and empty by aspiration
Make a small incision (~5cm) vertically into the inferior presenting part of the uterus until amniotic fluid comes or through endometrium
Insert 2 fingers and lift up uterus from foetus
Extend uterine incision up to fundus with safety scissors curved away from foetus
Deliver the foetus. May need to disengage the presenting part from the pelvis.
Clamp the cord twice and cut between clamps
Give the neonate to the neonatal resuscitation team” (2)
